Hadziselimović F, Herzog B
University Clinics, Basler Children's Hospital, Basel, Switzerland.
J Urol. 1997 Sep;158(3 Pt 2):1193-5. doi: 10.1097/00005392-199709000-00130.
Infertility has been considered a principal complication associated with cryptorchidism. A particularly high incidence of cryptorchid boys lack the priming effect during the first 3 months of life due to low concentrations of gonadotropins and testosterone (inadequate perinatal stimulation of the testes, which causes infertility). This condition causes impaired transformation of gonocytes into fetal spermatogonia. More pronounced hypogonadotropic hypogonadism results in fewer germ cells. Most importantly, cryptorchid boys with fewer than 0.2 cells per tubular cross section have a high probability of being infertile in adulthood, regardless of whether the condition is unilateral or bilateral and despite apparently successful orchiopexy.
To counteract the paucity of priming hormones, cryptorchid patients with unilateral or bilateral cryptorchidism and a severe paucity of germ cells were treated with a low dose of the luteinizing hormone-releasing hormone analogue buserelin after successful orchiopexy. We analyzed the spermiograms of these patients, who are now young adults, and compared them to those of 23 other men who also had cryptorchidism with a comparable severe paucity of germ cells but who had not received hormonal treatment after successful orchiopexy.
Patients who received hormonal therapy after orchiopexy had significantly improved spermiograms compared to those in the control group. Treatment with buserelin increased the number of spermatozoa, improved motility and increased the number of normal forms of spermatozoa.
The luteinizing hormone-releasing hormone analogue buserelin, administered as a nasal spray every other day for 6 months following successful orchiopexy, appears to have a long lasting, positive effect on germ cells. Consequently, the prognosis of fertility has been greatly enhanced in patients treated with buserelin.
不育一直被认为是隐睾症的主要并发症。隐睾症男孩的发病率特别高，由于促性腺激素和睾酮浓度低（围产期对睾丸的刺激不足，导致不育），在出生后的前3个月缺乏启动效应。这种情况会导致生殖母细胞向胎儿精原细胞的转化受损。更明显的低促性腺激素性性腺功能减退会导致生殖细胞数量减少。最重要的是，无论隐睾症是单侧还是双侧，也不管睾丸固定术表面上是否成功，每管状横截面积少于0.2个细胞的隐睾症男孩成年后不育的可能性都很高。
为了抵消启动激素的缺乏，对单侧或双侧隐睾症且生殖细胞严重缺乏的隐睾患者，在成功进行睾丸固定术后，用低剂量的促黄体生成素释放激素类似物布舍瑞林进行治疗。我们分析了这些现已成年的患者的精液图，并将其与另外23名同样患有隐睾症且生殖细胞严重缺乏但在成功进行睾丸固定术后未接受激素治疗的男性的精液图进行了比较。
与对照组相比，睾丸固定术后接受激素治疗的患者精液图有显著改善。布舍瑞林治疗增加了精子数量，提高了活力，并增加了正常形态精子的数量。
在成功进行睾丸固定术后，每隔一天以鼻喷雾剂形式给予促黄体生成素释放激素类似物布舍瑞林6个月，似乎对生殖细胞有持久的积极影响。因此，接受布舍瑞林治疗的患者生育预后得到了极大改善。
